Addressing Car Sickness and Anxiety

This article was originally published in the Pet Professional Guild‘s magazine “Barks from the Guild” in September 2018 under the title Overcoming Car Sickness and Anxiety.

Many people are left scratching their heads when it comes to car sickness and anxiety. It often feels much like a chicken or egg question: which came first? Why is my dog getting sick in the car? Is it because he’s anxious about being in the car and this makes him feel sick? Or is my dog suffering from motion sickness and has become anxious in the car because of this? Many people do lots of experimenting to see if they can work it out: over the counter medications, pheromones, crates and confinement and so on. It makes sense to explore the two components separately, but doing so effectively can be a bit tricky.

I’ll use my own dog, Hazel, as an example. After bringing her home, we noticed that she seemed to get sick in the car when we were about ¾ of the way to where we were going- no matter how far or long the trip. We tried over the counter anti-nausea meds, Benadryl (an antihistamine)and pheromone sprays with little to no success. We tried short trips only, with little to no success. We tried confinement, with zero success. And through it all, her anxiety seemed to worsen, she’d drool, look around frantically and seemed afraid to move even a single muscle. The unfortunate part was that, throughout much of this period of trial and error, she was in foster care with us, and we had to drive her to the shelter, which was an hour away, for testing and medications for her mange. So she had many trips on which to 1.) feel sick and 2.) feel anxious. Looking back, it was the perfect set-up for creating a dog who would be anxious in the car for the rest of her life. Thankfully, once we had adopted her and switched to our own vet, we were able to get pharmaceutical relief for her in the form of the anti-nauseamedication, Cerenia. This was a crucial start to being able to break the cycle. But, it was only that: the start. Addressing the nausea allowed me to get to the work of addressing the anxiety. It was at this point I was extremely glad I was a dog trainer, because I knew that I could use the principles of desensitization and counterconditioning (DS/CC)to help my dog.

To help me get a better perspective on how veterinarians handle these issues, I asked my colleague, Dr. Rachel Szumel of Blue Lake Animal Care Center to fill me in on some of the decision-making vets do, based on owner reports.

First, I asked her if an owner is reporting car sickness if she prescribes medication right away and she answered affirmatively, stating that she may suggest an OTC motion sickness medication (like Dramamine) first, but that she sees less success with those. Her prescription go-to (and the medication that changed Hazel’s life) is Cerenia. The primary usage for Cerenia is exactly this: to prevent nausea due to motion sickness. Speaking from my own experience, it is incredibly effective and depending on the dog, simply ends the nausea and vomiting, or reducesthe nausea and vomiting to allow enough comfort for the training process to begin. And for many dogs, the training process is necessary, because the cycle of nausea–>vomiting–>anxiety or anxiety–>nausea–>vomiting has been going on for a while and the associations have been made and won’t be broken without some behavioral help. So, even if the dog is no longer getting sick, the underlying anxiety remains and needs to be worked on. The power of associative learning has been doing its work in the background, even if we aren’t aware of it. This is a good example, and reason, to discuss anti-anxiety medications with your veterinarian.

According to Dr. Szumel, for puppies, often addressing the motion sickness component solves the problem, but not always. Multiple unpleasant experiences can cause the development of a negative conditioned emotional response (- CER) and anxiety that needs to be worked on, just as in adult dogs. Thankfully, in these cases, we can use DS/CC in the exact same way. I had the opportunity to work with one such puppy a few years after working through it with Hazel, and using the same principles, was able to help little Bailey and her parents resume their trips to New England from Pennsylvania, which had temporarily been put on hold, due to Bailey’s extreme motion sickness and anxiety. In little Bailey’s case, she would start backing away from the car as soon as she was about 20’ away. This made the DS/CC a bit trickier and “splittier” than Hazel’s, but I was confident using a training plan, we’d get there and we did.

Here is an example of how a trainer or dog owner might set out to write a plan:

Step 1:If there’s a car sickness component: See your vet. I am a firm believer that “Can’t hurt, could help” might actually hurt. Here’s why: While we are dabbling in alternative remedies, our dogs are suffering. I learned this the hard way: while I was trying Benadryl, pheromones on bandannas and Dramamine, my dog was still getting sick in the car and the association was getting stronger- contributing to the anxiety factor. So, she was not feeling well and she was scared. And I was wasting money, letting my car get ruined and feeling helpless.

Step 2:Re-build a positive conditioned emotional response to the car.In Hazel’s case, I was able to do this in the car, as her anxiety didn’t kick in until the car was in motion. In little Bailey’s case, this involved starting way back from the car. When she saw the car, a steady flow of chicken began. We gradually and carefully closed the gap, always dropping back if she showed any signs of fear (in her case, this looked like backing away), moving closer (pushing) at clear signs of comfort, and sticking when she appeared neutral.

Step 3: Proceed based on the Push, Drop, Stick rules for fear and anxiety.Before moving forward in the plan, it’s important that we are doing so based on observation and not simply guessing. We will only move through the components that are scary for the dog if the dog is clearly comfortable. Though this may look different from dog to dog, most dog owners are able to identify frank signs of fear or anxiety in their dogs. Some may drool and whine, some may freeze and some may tremble, etc. It is critically important that we only push to a harder step on a clear +CER (the dog looks “happy” or is anticipating something, like your dog looks when you open the treat bag), we drop on fear (the dog is clearly still uncomfortable or avoidant) and we stick on neutral (no clear signs of a +CER, but also not looking uncomfortable).

Step 4: Break the scary components down.If the history is strong, many people can identify exactly at what point the anxiety starts. It might be when the door is opened, when the key goes into the ignition, when the gears shift, etc. This is important because if we don’t begin addressing the anxiety at that point, but later in the chain, we risk sensitizing the dog (making the anxiety worse) and have it start earlier in the chain.

Step 5: Begin taking short trips and gradually build to driving to places with positive outcomes.Start simply with driving down the driveway, and then around the block, to a nearby park, and so on. Many dogs only go for car rides when they are going to the veterinarian, and because that, in itself, can be scary, it’s no wonder that they develop anxiety (projects like The Academy for Dog Trainers Husbandry Project and initiatives such as Fear Free Pets aim to change all of that!). So as we proceed on resolving the anxiety, we want to provide some padding and opportunities for car rides that result in something the dog likes. For Hazel, that meant to a park around the corner for walkies, and for little Bailey it meant a quick drive to the tennis court, where she would meet and play with her housemate, Benny.

Step 6: Gradually increase the length of the car rides, interspersing short ones with longer ones.We don’t want to undermine all of our progress by taking radical jumps in duration. Hazel’s current vet is about a half an hour away, so we built up to that and included trips to a park that was about the same distance. We also concurrently worked on building +CERs to all things related to veterinary care, which I believe to be something very worthwhile for those dogs who have made a negative association there, as well.

*You can download this image and print/share by right-clicking and saving!

Some things to keep in mind:

1.) For dogs who have a mild fear of getting into the car, training an alternative behavior in the form of a Differential Reinforcement of an Incompatible Behavior (a DRI-such as hand targeting) can work very well.Check out the video below for an example of this, as well as a brief overview of my work with Hazel.

2.) The longer the negative association,or -CER, has been able to build, the more likely you are to have to break down more of the components. Pay careful attention each step of the way and always remember the PDS rules when writing your training plan, as you may have to insert some ‘splits’, or extra steps, along the way.

3.) According to Dr. Szumel, starting anti-nausea meds can be very important with puppies right away, as the longer they are getting sick, the more likely they are to develop anxiety. Her advice is to get started before the -CER really has a chance to set in, as this can often make the process easier. To that end, my work with little Bailey did proceed much more quickly and with less splits and setbacks than my work with Hazel, as the anxiety had less time to dig in and puppies tend to be more resilient.

4.) Avoid getting lured into “can’t hurt, could help” solutions. The internet is rife with information that can actually delay success *and* cause a worsening of symptoms in the meantime. Always speak to a veterinarian first, and consider medications where appropriate. Using medications only as a last resort may actually not only delay improvement, but cause a worsening of symptoms.

5.) Use situational medications as per a veterinarian’s advice when car rides are unavoidable, as this can help protect your training and allow you to continue moving forward and avoid setbacks.

Dr. Szumel concurs on the use of situational (anti-anxiety) meds for car anxiety and replied that the use ofalprazolam (xanax), trazodone, or a combination would be appropriate for people who need to have their dogs travel while working through a training protocol. This can help protect the training as you go.

Here’s a nice little video from Sylvia Borghardt, instructor of our course It’s Tricky, working with little Olly on overcoming his fear of getting into the car.

My go-to resources for finding trainers who are qualified to work with issues around fear and anxiety:

The Academy for Dog Trainers– You may also be able to find an Academy trainer who does distance consults and training. Please email info@academyfordogtrainers.com for more info.